Provider Demographics
NPI:1497970545
Name:COE, THOMAS E (PAC)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:E
Last Name:COE
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3439 CASEY STREET
Mailing Address - Street 2:
Mailing Address - City:LORIS
Mailing Address - State:SC
Mailing Address - Zip Code:29569-2903
Mailing Address - Country:US
Mailing Address - Phone:843-756-5300
Mailing Address - Fax:843-756-6059
Practice Address - Street 1:909 PIREWAY ROAD
Practice Address - Street 2:
Practice Address - City:TABOR CITY
Practice Address - State:NC
Practice Address - Zip Code:28463-8942
Practice Address - Country:US
Practice Address - Phone:910-653-2112
Practice Address - Fax:910-653-2346
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC100190363AM0700X
SCPA103363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC02787OtherBCBS
NC5950653Medicaid
SCE03PA0Medicaid
NC02787OtherBCBS
SCE03PA0Medicaid